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HomeMy Public PortalAbout9027 JAYLEE DR_Sewer_8/11/1955_sewer connection ({�� 1I/�_ rp, ���pR. .{I,�� pp��' PERMIT��q[ry�pg7py 76A6420 All PUC�AT.rM �,`,f O 'tl ©'ERY' IT • ��� 6&E•663 12.84 `'_:DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BU ADDRESS �vF� WM.J. FOX. COUNTY ENGINEER CASSATT D.GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT>TO FILL IN CROSS ST. LEGAL . DESCRIPTION LOT NO ) OWNER BLOCK TRACT U MAIL _ AD RESS• NO. OF BLDGS. SIZE OF LOT ,NOW ON LOT USE OF 'BUILDINGS DISTRICT NO. GROUP MAP BK, PG CONTRACTOR ADDRESS ',j I CONNECTION DATA CIT TEL. STATION -1-44-2 7 DEPTH - 94--STATE �� O MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY UPPER J.$YGEii" _ D TYPE OF CONNECTION LENGTH FROM ��yy No. DESCRIPTION OF WORK FEE °� GAB P.L. M.L.TO P.L. HOUSE SEWER CONNECTING TO - PUBLIC SEWER @ $ 3.50 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. � @/ JOB. N0. WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT'NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT $ 1 `00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTOR TTOSCONNECT OTHEAABOVE DESCRIBED EXISTINGADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC S WER SIGNED THIS DALOF r�1_ NEW HOUSE SEWER 19 //• P �/� OWNER ORC— CONNECT ADDITIONAL •c OWNERS AGENT 4 A BUILDING OR WORK SEPTIC TANK,-SEEP,PIT(S) ADDRESS '2 4;-1 r AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT T`HAV READ THI APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOV I CORK-t` AND AGREE TO COMPLY WITH ALL COUNTY ORDINS AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR / SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM/1OPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS4P1Jt6 FFF111GELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER F THE ABOVE ABANDON HOUSE SEWER - DESCRIBED RESIDENTIAL OPERTY. PLL SEPTIC TANKS SEE . El 8i SEEP. PIT(S) ❑ CESSPOOLS SIGNATURE- OF PERM ITT - - - - WILLIAM J. FOX, COUNTY ENGINEER- VALIDATION BY Co.6 5-2 5- -AUG 11 4 4.5 0 DEPUTY - ry DEPUTY BY BY .'0 DEPUTY —`—"r��• DEPUTY